d. Microorganisms Normally Present. The microorganisms normally
present on the skin can be classified as transient and resident.
(1) Transient organisms are those microorganisms that are introduced
onto the skin surface by contact with the soil and various other substances. Mechanical
scrubbing and surgical soaps will remove most of the bacteria.
(2) Resident organisms are those microorganisms whose natural habitat is
the skin. They are comprised mostly of gram-positive and gram-negative bacteria.
They exist in large numbers under the fingernails and in the deeper layers of the skin
(such as the hair follicles, the sweat glands, the sebaceous glands). Scrubbing
removes the resident bacteria from the surface and just beneath the surface of the skin.
After a time, the resident organisms in the deeper layers of the skin are brought to the
surface by perspiration and the oil secretion of the sebaceous glands and the bacterial
count is again increased. For this reason, sterile gloves are worn to prevent
contamination of the patient's wound and the sterile goods used in it by organisms from
e. Local Policy. The local policy (Standing Operating Procedure (SOP)) is
the final authority on the method employed for scrubbing the hands and arms and for
the type of surgical detergents to be used; policies vary among hospitals.
PURPOSE AND SCOPE OF THE SUBCOURSE
a. This subcourse sets forth effective procedures and techniques for
scrubbing, gowning, and gloving. In the absence of local policy, the specialist should
employ these procedures.
b. To obtain maximum benefit from the ensuing instruction, all procedures
should be practiced.
Section II. PREPARATION FOR SCRUBBING
a. Personal cleanliness is of extreme importance for operating room
personnel. A daily shower, frequent shampoos, and attention to hands and fingernails
are most important. Because of the close contact with other members of the "sterile"
team, personnel should also use a body deodorant. They should note and report to the
operating room supervisor any infection, rash, or open lesion about the hands, nails,
and arms. They should also report any signs of a cold or other systemic infection.